MACROSCOPE
An Engineering Approach to Translational Medicine
Physician-scientists may benefit from an approach that emphasizes solving problems over generating hypotheses
Michael Liebman
Heterogeneity of Breast Disease
Breast tumors are usually composed of more than one type of cancer.
This is a problem when the cancers do not all respond to the same
treatment. Although scientists know about this phenomenon, it has
been difficult to quantify because pathologists use differing
diagnostic criteria. In the CBCP, we have the advantage of having a
single pathologist review all patient samples. We think it likely
that when a tumor biopsy has a specific combination of subdiagnoses,
it is more accurate to describe the tumor in terms of its
heterogeneity rather than noting only the severest cancer (the
current convention). The CBCP categorization scheme contains 135
potential subdiagnoses for tissue sections. Among 891 patient
samples, we have observed 75 of these. Although most combinations
are rare or nonexistent, others are extremely common: We found two
cancers that had a 92 percent likelihood of showing up paired rather
than alone. This finding suggests that we may need to review the
tumor-classification system to reflect this heterogeneity, thereby
refining our evaluations of tumor stage and grade and improving
treatments for patients.
An engineering perspective analyzes breast cancer by viewing the
whole patient and applying customized treatments that reflect each
person's unique confluence of biology and experience. We hope that
this practice reinvigorates the study of breast cancer and other
diseases to enhance patient care—the ultimate goal of
translational medicine. To my basic-science colleagues, I say that
our engineering counterparts have been looking at the world through
somewhat different glasses, and perhaps it is time to share the view.
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